How prenatal counselling can help you through pregnancy

For many women, pregnancy isn’t all glowing skin and playing baby Mozart to their growing bellies. First-time mom Kayla Morton recalls that, for her, pregnancy was also about “feeling betrayed by my changing body, worrying about my capacity to put a small human’s needs before my own and legitimate fear about my body’s ability to survive childbirth.”

Prenatal counselling provided a safe space for Morton to talk about these often not talked about concerns. Her only regret is that she didn’t go sooner. “I didn’t really know this kind of help was available,” admits the 32-year-old Vancouverite. Her lack of knowledge isn’t surprising—unlike other types of therapy used during the prenatal period (like massage for an achy back or physiotherapy for pelvic floor pain), prenatal counselling is often misunderstood and underutilized. It wasn’t until a friend recommended her own prenatal counsellor that Morton took the plunge and made an appointment.

So what is prenatal counselling? According to Shannon Kane, owner of Birth Narratives Counselling in Calgary, the transition to parenthood can result in “a lot of joy mixed in with loss and fear.” Prenatal counselling helps women sort through these conflicting emotions, bolstering mental wellness while baby is still in the womb. But it’s not just for soon-to-be moms—it’s also great for partners and for families with another kid (or two) in tow.

Many parents and parents-to-be are probably wondering right about now how they’d fit one more appointment into their already-crammed schedules. However, Kane stresses that “a single session of counselling can sometimes be enough to help parents notice the resources and skills they already have to bring into their pregnancy and parenting.” Although Morton’s counselling took about eight sessions, she says, “my counsellor helped me realize, OK, I actually can do this motherhood thing.” She talked to the counsellor about her fears and uncertainties about pregnancy and motherhood (and where they were coming from) and her counsellor helped to normalize her experiences.

Although expectant parents attend prenatal counselling for all sorts of things, here are four common reasons they seek support.

Body image During Morton’s pregnancy, she’d compare her bump to other women’s, wishing hers was cuter or smaller. “It was heartbreaking to hate my body when I knew I was supposed to love it,” she recalls. Morton certainly isn’t alone. According to Jen Reddish, a counsellor at The Essence of You in Calgary, who specializes in body image, motherhood, and the perinatal period, many women have difficulty accepting the changes their bodies go through during pregnancy. Reddish’s practice involves helping her clients manage triggers, challenge unhelpful thoughts and behaviours, and “dig deeper to identify the root causes.” She adds that women who seek support with body image during pregnancy are better equipped to handle the new wave of physical changes that occur postpartum, and are better able to accept—and even embrace—their postpartum bodies.

Stress and expectations Women face a lot of pressure when it comes to growing a baby. Constant messages remind them about the gazillion things they’re doing wrong (“You’re still drinking coffee? And is that a gel manicure?”) and about the gazillion-and-one things that could go wrong. According to Kane, counselling can help women “sift through all the information on how to ‘do’ motherhood and what to do with the ‘perfect’ mother images that are portrayed on social media.” She adds that, “we need to remember there is no perfect way to parent—you will make mistakes and this will be OK.”

Anxiety and depression For some women, the normal worries and ups-and-downs of pregnancy become a lot bigger, resulting in prenatal anxiety or depression. Unfortunately, these mental health concerns often go untreated and can cause big challenges for both them and their babies. Not only are anxiety and depression during pregnancy strong predictors of postpartum depression, they’ve also been linked to things like preterm birth, difficult infant temperament, and child behavioural and emotional problems.

Counselling can screen for these mental health concerns early on, and help women to learn coping strategies and lifestyle changes that can make a huge difference. Kane shares that part of her work is to create a postpartum mental health plan for parents. Although every plan will look a bit different, they generally involve pre-emptive arrangements like postpartum counselling appointments or a partner taking extended time off work. A plan may also include educating partners about what’s normal and what’s concerning in regards to mental health (for example, what the baby blues look like compared to depression), and guidance on helpful ways to support one’s significant other (for example, by checking in regularly on how they’re feeling and seeking additional support from a family doctor or postpartum doula).

Trauma Unfortunately, childbirth doesn’t always go as planned. Thus, a large part of Kane’s practice involves working with clients who have experienced a childbirth trauma, such as an emergency C-section or instrumental delivery. For these women, things like flashbacks, nightmares, and lack of trust in care providers can re-emerge during subsequent pregnancies. Kane uses various tools to help her clients work through difficult memories and stay focused on the present pregnancy and birth experience. 

Think you could benefit from prenatal counselling? Search for a licenced mental health professional (for example, a registered psychologist, Canadian certified counsellor, or registered social worker) and inquire about the person’s training, approach to counselling, and experience working with prenatal concerns. And just like you hunted down that perfect stroller, be picky about finding the right counsellor for you. A large body of research suggests that a strong relationship between counsellor and client is one of the most important factors contributing to a positive outcome in therapy.

Amy Green is a doctoral candidate in counselling psychology at the University of Calgary. Her work focuses on women's holistic wellbeing in areas such as body image, motherhood, and prenatal and postnatal mental health.

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